using simulation to drive changes in health and social care
DESCRIPTION
Using simulation to drive changes in health and care - long term conditions Year of Care model Bev Matthews and Claire Cordeaux Presentation from Day 1 of the Health and Care Innovation Expo 2014, Manchester CentralTRANSCRIPT
Long Term ConditionsYear of Care Commissioning Programme
Bev Matthews - Programme Delivery LeadJamie Day - Healthcare Finance and Information Specialist Claire Cordeaux - Executive Director, SIMUL8Healthcare
Context
• 15m people with Long Term Conditions• Increasing each year with ageing population• Responsible for 70% of NHS costs• Significant cause of ED attendance and urgent admission
Driving Policy through Funding Instruments
• A year of care capitation fund for a person living with multiple conditions
• Incentivizing providers and commissioners to work effectively together
• Aligning funding flows and patient need for support• Improving outcomes and efficiency• Reducing emergency care activity
Silo treatment vs. whole person
Sir John Oldham, DH
What if?
• We plan care for people rather than disease?• Are there common patterns of service use?• Can we differentiate groups of patients by need and costs
to create an annual tariff?• Can we work within that tariff to reduce emergencies and
manage care out of hospital?• Where should we intervene to stop progression to multiple
long term conditions?
Launched in June 2012 under Dept of Health QIPP programme
Transferred to NHS England in December 2013
SRO is Dr Martin McShane, Director Domain 2
7 Early Implementer Sites
22 Fast Followers
Background
Early Implementer Sites
Health Economy Early Implementer
Key Partners Regions
Leeds Leeds South and East CCG, Leeds West CCG, Leeds North CCG, North
Southend Southend CCG; Southend Council Midlands and East
Kent Kent County County (Social Services Dept), Kent Community Health Trust, East Kent University Hospital FT, Maidstone Foundation Trust, Darent Valley Hospitals FT, Canterbury CCG, Thanet CCG, Swale CCG, Ashford CCG, South Kent Coast CCG, West Kent CCG, Dartford and Gravesham and Swanley CCG.
South
North Staffordshire and Stoke on Trent
Stoke on Trent CCG, North Staffordshire CCG; Stoke on Trent Council; Staffordshire Joint Commissioning Unit; University Hospital of North Staffordshire; Staffordshire and Stoke on Trent Partnership Trust, North Staffordshire Combined Healthcare Trust; West Midlands Ambulance Trust
Midlands and East
West Hampshire West Hampshire CCG; Hampshire County Council; Hampshire Hospitals NHS FT; Southern Health NHS FT. South
Barking, Havering and Redbridge
Barking and Dagenham CCG; Havering Emerging CCG; Redbridge Emerging CCG; Barking & Dagenham Council; Redbridge Council; Havering Council; NHS Outer North East London; Barking, Dagenham and Redbridge University Hospitals Trust; North East London NHS FT.
London
Kirklees North Kirklees Emerging CCG; Greater Huddersfield CCG; Kirklees Council; NHS Calderdale; Mid Yorkshire Hospitals Trust, Calderdale and Huddersfield FT; Local Community Partnership; South West Yorkshire Partnership; Kirkwood Hospice.
North
Benefits
Improved outcomes and wellbeing:• Patients receive care that is better managed, more seamless across different care
services and more needs focused.• Reduction in acute admissions to hospital; and shorter lengths of stay when these
are required.• Clinical professionals contribute to a more holistic service for patients by working
within an integrated patient-centred care plan
Local health & Social Care economies: • Provide care that delivers value for money and is better managed by integrated
teams.• Incentive to improve services for patients• Improved joint working and shared responsibility for outcomes
Recovery, rehabilitation & Reablement clinical audit: To support local thinking about RRR and early discharge, particularly in relation to
potential for pathway changes. To assess the appropriateness of methodology for long-term conditions (COPD,
diabetes, stroke and heart failure), particularly whether there is scope to unbundle the RRR service from the Acute Provider PbR tariff.
Costing dataset Support the development of local tariffs for LTC YoC currency Looking at longitudinal data to support the discussions/understand the impact in
changing pathways
Whole Population Gives the evidence to support the currency framework Validates the framework
Data Collections
• Stakeholder engagement and senior team ‘buy-in’ • Assessment of services to maximise the benefit of integrated care • Learn from research, eg models of care, contracting models,
weighting LTCs for local tariff• Planning for improvement in data quality and implementation of
shadow testing• Assessment of systems and processes to support YoC currency• RRR clinical audit• Local analysis and collection of data to support national analysis• Local tariff development• Share learning with other health economies and national
stakeholders
Early Implementer Sites Deliverables
• Senior team ‘buy-in’, eg NCDs• Stakeholder Engagement, eg Monitor and PbR Team• Framework for the Model and vision for future years• SIMUL8 Model for redesigning services• Data analysis and comparison • Programme Management and EI site support • Resolution of barriers, eg Information Governance
National Support Team Deliverables
Using Simulation to Drive Changes in Health and Social Care –
LTC Year of Care Commissioning Programme
Agenda
• What is simulation? • Why use it in
healthcare?• Learning from the data• Simulating long term
conditions for the Year of Care
Where does simulation help?
• Modelling uncertainty• Testing assumptions and their consistency when no
historic data• Considering variability• Driving thinking• Sharing models
Our task
• Create a simulation model• 7 pilot sites• 1 national model to be used locally
Looking for common parameters
What is simulation and why use it?
Models a flow of events
Small scale operations
Service operations
Whole system
Passing of time
Arrivals
Duration of treatment
Time between treatments
Waiting times and bottle necks
Experimentation
What if?....
No risk to patients through pilots
ResultsCosts
Resource utilisation
Waiting times
Operating Theatre, Emergency Department, Beds, Disease Pathways, Reconfiguration...
Patients come into a clinic for treatment
They arrive every 5 minutes
The treatment takes 10 minutes
A simple simulation
- What is the likely demand?- How many clinicians do I need?- What is my revenue/cost?- How long are patients waiting?
A simple clinic – a typical week
Benefits of simulation
Risk- Free Uses data intelligently
Increases confidence in decision
making
Test and compares potential solutions
More accurate than
a spreadsheet
Models variability
Simulates the passing of
time
Visual-Engages
Stakeholders
Planning for Healthcare
How much can I
spend?
How much resource
have I got?
What is my demand likely to
be?
How long is it
reasonable for patients
to wait?
What are my
expected outcomes?
Financial Winners and Losers
Starting to simulate a new approach
Services “consumed”
Assessment of Need
Patients at Risk
Exacerbation
But……
• No real correlation between risk score and level of need
Assessment of Need
Patients at Risk
What the data is telling us
Over 30% of people over 75 years have multimorbidity
Kent whole population data
Multimorbidity is more common than single morbidity
Kent whole population data
The total health and social care cost is strongly related to multimorbidity
Kent whole population data
The main contributors to total health & social care cost are acute non-
elective admissions
Kent whole population data
People with complex health & social care needs appear to demonstrate a
‘crisis curve’
Kent whole population data
More community, mental health and social care services are delivered to
people following a ‘crisis’ than before the ‘crisis’
Kent whole population data
Some indications that an integrated care plan changes the pattern of
services delivered to people
BHR costing data
Implications• Evidence suggests that once people with complex care needs (multimorbidity) are
identified, the services delivered to those people changes• If people with complex care needs could be identified before the ‘crisis curve’,
service changes could be put in place that may prevent some of the non-elective acute care
Year of Care currency incentives• Providers to work together to deliver cost-effective care• Payment based on holistic outcomes not episodes of care
LTC Year of Care programme encourages• Integrated care for a patient-centred and seamless patient pathway• Sharing of evidence to support service change (e.g. SIMUL8)
Current Simulation
• Likelihood of patients accessing services by changing state of patients
– Level of acuity– Increasing numbers of long term condition
How it works
• Patients in each “state” have– A likelihood of accessing certain types of service
(Acute, Community, Mental Health, Social Care), including accessing services more than once
• Costs associated with those services
Results
• Number of patients in each “state” by year• Costs by state per year• Comparison with locally determined tariff
Testing, testing…
• Beta being tested with site data for year 2• Comparing patients cared for by integrated care teams or
not• Tested by sites for usability
What the simulation does…
• Informs question development and data collection• Allows experimentation and hypothesis testing where
no historic data available• Enables research evidence to be applied to policy and
practice development• Shares national assumptions meaningfully at local level• Reduces risks in policy development by generating
evidence for decisions
@NHSIQ
www.nhsiq.nhs.uk
Improving health outcomes across England
by providing improvement and change expertise
Available on NHS Improving Quality Stand
“Integration is a means to an end; the purpose is about better person centred care and better outcomes – it’s about privileging, autonomy, prevention and wellbeing.”
“It’s about two organisations working together with the benefit for users of the services at the heart.”